Answers To Your Questions About Premature (Forcible) Retraction of Your Young Son's Foreskin

from the

National Organization of Circumcision Information Resource Centers

Educating A New Generation For The Well-Being Of All
Children.

www.nocirc.org

Now that more males are growing up with their foreskins intact, NOCIRC
is getting an increasing number of calls from parents whose son's
foreskin was retracted prematurely by a healthcare professional, the
child's caregiver, or even the child himself.

This pamphlet is to help parents protect their
child from premature foreskin retraction and to help them know what to
do if forced retraction occurs.

What do I need to know about the foreskin?

Almost all males are born with a fold of specialized skin - a foreskin
(also known as the prepuce) - that covers their glans (head of the
penis) and, in many males, extends beyond it.

In infancy and usually during childhood, the inner
surface of a male's foreskin and the surface of his glans are one
continuous structure.

The cells that connect these two surfaces dissolve naturally over time - a process that should never be hurried.

What is foreskin retraction?

The foreskin is retracted when it is behind the glans instead of covering it.

The foreskin becomes retractable when its inside
fold separates from the glans and its opening widens. This usually
happens between early childhood and sometime after puberty. Even if the
glans and foreskin separate by themselves in infancy or early
childhood, the foreskin may still not be retractable because its
opening may still be just large enough to allow for the passage of
urine. This is normal.

After the foreskin separates from the glans and its opening widens, a boy can retract his own foreskin, without pain or injury.

Who should be the first person to retract the child's foreskin?

The first person to retract a child's foreskin should be the child himself.

A boy should not be coaxed or urged to retract his
foreskin. In early childhood, a boy will pull his foreskin out, away
from his body, assisting the separation of the foreskin and glans. As
he gets older he will begin to pull it towards his body, too, and one
day he will discover that he can pull it all the way back behind his
glans.

Many boys do not develop fully retractable foreskins until after puberty. This is normal.

How can I protect my son?

Parents of an intact boy often know more about the
structure, functions, development, and care of the normal penis than
their son's physician. Most medical doctors in the U.S. today have
little or no knowledge about the foreskin because they were not taught
about it in medical school. Many still do not know that a child's
foreskin and glans begin as one structure, separate in time naturally
on their own, and should be allowed to do so.

Tell your son's doctor — before his newborn examination and before
every examination thereafter — that your son is intact and that you do not want
his penis touched or his foreskin retracted. Then, watch carefully to make sure
the doctor respects your wishes. NOCIRC continually receives calls from parents
who told the doctor not to retract their child's foreskin, only to have the
doctor retract it anyway.

"The foreskin therefore can be likened to a rosebud
which remains closed and muzzled. Like a rosebud, it will only blossom
when the time is right. No one opens a rosebud to make it blossom."

H. L. Tan, MD

Would my son's foreskin need to be retracted if he were catheterized for a urinalysis or medical treatment?

No. A catheter can be inserted when the foreskin is retracted just
enough to see the meatus (urinary opening). if the foreskin's opening
is too small to retract far enough to see the meatus, a catheter can be
inserted through the foreskin's opening and into the meatus "by feel."
The foreskin should never be retracted by force for any reason.

What happens if my son's foreskin is retracted by force?

Forced retraction of the foreskin causes pain and trauma because it
rips the child's foreskin from his glans and/or tears his foreskin's
opening. Creating raw surfaces on the foreskin and glans can cause the
following problems:

Infection. There is now an opening through which bacteria can enter the body.

Adhesions. The two raw surfaces grow together as they heal, often requiring surgery to make foreskin retraction possible later.

Acquired Phimosis. The foreskin's narrow opening sometimes tears
when the glans is forced through it, forming scar tissue that may
prevent it from widening later on its own.

Paraphimosis. When a child's foreskin is retracted by force, its (narrow)
opening may "get caught" behind his glans, and, like a tourniquet, trap blood
in the glans and make it swell. Many physicians recommend circumcision to "correct"
this, but the foreskin can be brought forward without cutting by holding the
shaft of the penis and gently pushing the glans into the foreskin. If this doesn't
work, squeezing the glans to reduce swelling should help slip it back inside
the foreskin. If these techniques fail, putting ice on the glans or injecting
the swollen foreskin with hyaluronidase usually allows the foreskin to be returned
to its normal forward position.

What should I do if my son's foreskin is forcibly retracted?

Regardless of your son's age, first explain that you didn't
know anyone would do that to him, apologize, and tell him you will do
your best to make sure no one ever does that to him again.

If your son's penis is swollen, sitz baths will help relieve the swelling and discomfort.

If it hurts your son to urinate, put him in the
bath several times a day so that his urine will be diluted by the bath
water, then rinse him off. Do not use soap on his penis.

Even if you have been told to retract your son's
foreskin, don't. He has been hurt and traumatized and his penis needs
to be left alone to heal.

Watch for infection.

Your son may develop adhesions when his foreskin
and glans heal but you might not know whether these have separated by
themselves or will need to be separated surgically until he has
completed puberty.

No one except your son should manipulate his penis
to check for adhesions or to see how far his foreskin will retract. A
narrow foreskin deserves the same respect as a tight hymen. Both
openings will enlarge with sexual maturity.

What legal and/or regulatory action can I take?

David J. Llewellyn, J.D., of Atlanta, Georgia, states:

"Generally the law does not permit a physician to
carry out a non-emergency invasive or damaging procedure on a child
without the parent's permission. If an infant's foreskin is forcibly
retracted, resulting in tearing and pain, and the parents have not
given their permission for the procedure, the law of most states
provides that the parents may bring a suit on behalf of the child for
assault and battery against the physician. Parents should be aware of
these facts and should consult competent counsel if their child has
been forced to suffer unnecessary pain without their permission."

Parents of boys whose foreskins have been forcibly
retracted may want to consult competent, knowledgeable legal counsel
about initiating litigation to recover money damages on behalf of their
son.